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Friday, July 15, 2016

Vietnam - Public hospitals prepare for autonomy

The HCM
City Department of Health has encouraged public hospitals to begin preparing
for full financial and managerial autonomy, following a recent requirement from
the city’s Party Committee.

Financial
autonomy among hospitals is designed to help reduce state expenditures so that
funds can be diverted to preventive medicine and targeted community-care
programmes.

Reduced
state spending will also allow the state to pay for more health insurance cards
for the poor, including those near the poverty line and patients covered by
state policies.

Public
hospitals in HCM City that have already achieved 50 per cent autonomy will be
expected to implement full autonomy by January next year.

Of the 54
public hospitals in the city, seven have carried out 100 per cent financial
autonomy and 44 partial financial autonomy.

The three
remaining hospitals, which include a new paediatrics hospital, and two for
leprosy and HIV patients, have still been subsidised by the state.

Trương Thị
Xuân Liễu, chairwoman of the HCM City Medical Association and former head of
the Department of Health, said that autonomy had helped hospitals identify
their most important needs.

“The
government’s subsidy to public hospitals had restricted their development, and
full autonomy had brought benefits to both patients and the hospitals.”

However,
"full autonomy brings with it added responsibilities," Liễu noted,
adding that the government should develop a strict legal framework to minimise
problems.

Dr Trần
Văn Khanh, head of District 2 Hospital, which has carried out full autonomy
since mid-May, said the state subsidy had been insufficient for hospital
expenditures.

“The
subsidy is based on the number of beds. This is inappropriate, especially for
outpatient healthcare services,” Khanh said.

To raise
money, many hospitals, with or without autonomy, often offer health exams and
treatment at times outside normal working hours and give periodic check-ups to
staff at local businesses.

Khanh
said that funds from extra exams and services helped pay for staff salaries and
allowances.

Better
service quality

With full
financial autonomy, hospitals are required by the state to improve the quality
of healthcare services, as well as the attitudes of doctors and nurses and
other staff when they are serving patients.

They also
must simplify administrative procedures and shorten the waiting time so they
can admit more patients.

Dr Lê
Hoàng Quí, deputy head of Bình Thạnh District Hospital, which was the first
district-level hospital in HCM City to carry out full autonomy in 2015, said
that a long-term strategy had been created to improve quality.

“If
hospitals don’t change, patients will not come,” Quí said.

In 2010,
the hospital took steps to increase funding when it adopted the view that
patients would be “the main source of income”.

Changes
in administrative methods such as IT applications and simplification of health
examination and treatment processes have also been created.

To raise
funds, the hospital conducts medical exams and treatments at 6am each day and
on weekends as well as holidays.

As a
result, it has seen an increasing number of patients. In 2014, there were 2,000
patient turns per day, rising to 2,400 in 2015. It is expected to rise to 3,000
in 2016.

“Thanks
to autonomy, better quality is available for patients,” Quí said. “The income
of the hospital’s staff has risen and we now have funds to reinvest in
equipment and other facilities.”

Full autonomy
has also allowed the District 2 Hospital to make independent decisions on
buying medical equipment and medicine, as well as hiring professionals to
improve quality. This has led to increased trust from patients.

The
hospital, which has 25 specialised wards, plans to set up wards for cardiac
intervention, dialysis, chemotherapy for cancer, and hepatitis C by 2018.

Though
the hospital has financial autonomy, it charges medical fees according to the
regulations of the Ministry of Health.

“This
won’t affect poor patients. The hospital in recent years has allocated VNĐ350
million-500 million a year to help poor patients,” Khanh of District 2 Hospital
said.